We have a few minutes for some discussion prior to the voting. Any questions? I'd like to just start off. Let's say that the patient does not have a virus alignment or arthritis and they present with an acute root tear. Is there any role for nonoperative treatment? We'll start with Eric. So especially at this age, you know, the data is very clear. There's all the biomechanical studies, a lot of work by LaPrade. When that root's not there, it's essentially like there's a nonfunction or nonexistent meniscus. So unless there's an absolute contraindication to surgery, I'm pushing a root repair in that patient that has a pretty much otherwise normal knee to give them the highest likelihood of healing and of, you know, kind of correcting that natural history. Seth? I agree completely. I think in these middle-aged, you know, females, they have a low energy pop. They have a root tear without significant chondrosis or malalignment. That natural history, I think, is very poor and I'm fixing those or giving them a rationale almost right away, if not right away. And how about technique? I saw you used three sutures for the root part. Seth, are you a multiple suture user or multiple tunnels or just single suture? We'll get into it in the debate session, or excuse me, in the case panel in a moment as well. But usually I'm using two sutures now, cinch-type configuration. I'm doing a single tunnel and I'm using a knotless anchor on the tibia. How about rehabilitate? Sorry, Brian, go ahead. Oh, no, no. I was just going to take the tibia. Sorry. Thank you. Thanks, guys. That was a great session. Eric, I agree. I wish four of you were able to change that, what you were given. But Seth, practically, in that patient, young, active, agree with HTO, asymmetric barriers, blah, blah, blah. But would you have also repaired the root? Yeah, I think, you know, I was asking a couple of colleagues, you know, how much experience they have with that combo and, you know, I don't think many of us have a huge experience with this. I was looking into some of the patient-specific instrumentation designs for this that might help us avoid the screw trajectories, but still technically challenging. Answer, yes, I would repair the root. I think the all-suture device that Eric showed is actually a really nice way that you can get aperture fixation and avoid the saw cut. So, we weren't given that option. I would, clearly, that's the point of the debate, but I would absolutely, in that young patient, you know, and anything younger with a root repair with varus, I'm going to address both. And you do have the benefit of the companies with patient-specific instrumentation where the angle for that root tunnel can be drilled through your HTO plate, and I think you're basically addressing all bad actors and giving them the highest likelihood that you're going to correct all and give them the longest-term benefit. So, I would have, for this particular patient, I would have done both. Hey, Eric, walk me through the Cell speech on limited weight-bearing. In New York City, after a root repair, how long are you doing it? Meanwhile, Seth's patient is comfortably walking around Northern California, you know, what's your post-op rehab, and how do you sell it to the patient? Yeah, so it's clearly not an easy sell, and it's, you know, oftentimes, this is the patient that gets my cell number that we can then talk afterwards because I'm throwing a lot at them. We actually wrote, like, a decent review article. I print it out and hand it to them for a little homework, but they're going to be non-weight-bearing for eight weeks. I will unlock their brace to 90 degrees at the first post-op visit, but I'm not going to let them go past 90, basically, until six weeks. It's a long haul. They have to realize that this thing doesn't want to heal. When they put weight on it, the sheer forces of that femur on the back of the tibia are fighting everything we're trying to achieve, so you need to get them to buy into the fact that they're going to be non-weight-bearing until that thing is healed enough that it can tolerate the stresses, and if they want a decent outcome, they've got to stick to it at least early. And I just want to be realistic. I mean, I am under no pretense that the HTL option is a less morbid or small intervention, so they're not comfortably walking out of my office. They're, you know, having pretty extensive rehab as well. Whether they weight-bear on it earlier and with less detriment than a root repair when they're going to load it and destroy that root is a different story, but it's not an easy thing to sell or to do. Thank you very much. There's plenty of opportunity for further discussion on this topic, but we're out of time, so after all those first-rigged ANA cases with the skewed voting, it looks like Sachin evened things out a little with that case. So we can start with the voting, please. We have a minute of voting. At least I got something. A hundred percent. I may need to take this into the hallway to settle this like men. That hurts. Could have been worse. All right, voting's just about done. Come on, bring it. We're just going to let it go a little longer to see if ANA truly did rig it. All right. I'm not saying the writing's on the wall, Eric. David, they can't do that to us, can they? Call it. Thank you.

acute root tears

nonoperative treatment

surgery

root repair

rehabilitation strategies